Update on Mechanical Ventilatory Strategies

Abstract

Mechanical ventilation is essential for survival of many extremely premature infants, but all forms of positive pressure ventilation are to some degree injurious to the lungs. A variety of sophisticated devices are used to provide respiratory support, yet substantial uncertainty remains regarding the optimal ways in which these tools can be used to minimize ventilator-associated lung injury. A good understanding of the unique aspects of respiratory physiology of extremely preterm infants is key to obtaining the greatest benefit from modern ventilator technology. Early lung volume recruitment with adequate end-expiratory pressure, avoidance of volutrauma during the immediate postnatal period, and noninvasive respiratory support as the initial strategy are now accepted as important factors in minimizing lung injury. Volume-targeted ventilation combined with optimal lung volume strategies to ensure that the tidal volume is evenly distributed throughout an open lung seems to be the best approach to lower the incidence of bronchopulmonary dysplasia.